Using Painkillers During Pregnancy

Prescription painkillers, or opioids, are commonly used to treat pain. Opioid painkillers include drugs such as hydrocodone (Vicodin), oxycodone (OxyContin), codeine, and morphine. In addition to their inclusion in the many opioid analgesic formulations, opioids are also found in some prescription cough medicines 1.

Opioids exert their painkilling effects by binding to opioid receptors in the brain. For many people, the pain relief experienced after taking opioids is often accompanied with euphoric or rewarding sensations that promote continued use. However, these pleasurable effects come with some serious dangers as use increases. Too-high or too-frequent doses can result in respiratory depression, coma, and even death.

The rates of prescription painkiller use and abuse are rising in the United States, and pregnant women are no exception. According to the Centers for Disease Control and Prevention (CDC), 28% of women who were of reproductive age (15-44 years old) and who had private insurance filled a prescription written by a healthcare provider for an opioid medication. The number is significantly higher in the Medicaid population, with 39% of women who were of reproductive age filling a prescription 2. With more women of reproductive age taking these drugs than ever before, opioid use during pregnancy has become a major concern in the medical community. The potential effects of opioids on a pregnant mother and her developing baby are troubling.

Did You Know?

Data from a study in Tennessee found that 29% of pregnant women enrolled in Medicaid filled a prescription for an opioid painkiller between 1995 and 2009. A nationwide study of Medicaid-enrolled women found that 21.6% filled at least one opioid prescription during their pregnancy.

The most commonly filled opioid painkillers in these studies included codeine, hydrocodone, oxycodone, and propoxyphene 6.

Effects of Opioid Painkillers on a Developing Fetus

A developing fetus who is exposed to opioid painkillers in utero is at a higher risk for complications.

A population-based study led by the CDC found a link between birth defects and opioid painkillers taken during pregnancy. The CDC study found an association between the following conditions in babies and opioid painkiller use by the mother 1:

In this study, researchers noted asignificant increase in the number of heart defects a baby had, including hypoplastic left heart syndrome 1. Hypoplastic left heart syndrome is a condition in which the left side of the heart doesn’t develop correctly.

One study found that when women used opioid painkillers right before they got pregnant or during the first trimester of their pregnancy, they were twice as likely to have a baby born with a heart defect 1.

Taking opioids during pregnancy might also cause 3:

Preterm birth (before 37 weeks’ gestation).

Neonatal abstinence syndrome (NAS).

Some studies found that opioid use during pregnancy is associated with clubfoot and cleft lip 4. However, the findings are not consistent and warrant further investigation.

Despite the evidence of possible negative effects that opioids can have on a developing fetus, studies show that opioids remain among the most commonly prescribed medications used by pregnant women.

Neonatal Abstinence Syndrome (NAS)

When a woman uses opioid painkillers during pregnancy, it can cause her baby to develop neonatal abstinence syndrome (NAS)—essentially, opioid withdrawal.

NAS can occur when a pregnant woman takes opioids, such as 5:

Codeine.

Oxycodone (OxyContin, Percocet).

Methadone.

Hydrocodone (Lortab, Norco, Vicodin).

When a pregnant woman uses substances such as opioid painkillers, the drugs can pass through her placenta. The placenta connects the developing fetus to its mother. This results in the baby developing a dependency to opioids along with the mother. If a pregnant woman uses drugs during the week or so before she delivers, the chances are extremely high that her baby will be born with a dependence on the drug at birth. After birth, the newborn’s supply of drugs is abruptly cut off, potentially causing withdrawal in the newborn 5.

The severity of a baby’s withdrawal will depend on several factors, including 5:

How much of the drug the mother used and for how long.

How well the body clears the drug out of its system.

What type of opioid the mother used.

Whether the baby was born early.

NAS symptoms can begin 1-3 days after the baby is born. If doctors believe that the baby may be at risk for more complications, they may have the baby stay at the hospital for up to a week for medical supervision and monitoring.

Symptoms of NAS might include 5:

Blotchy skin coloring (mottling).

Rapid breathing.

Stuffy nose and/or sneezing.

Sweating.

Vomiting.

Diarrhea.

Excessive crying or high-pitched crying.

Irritability.

Sleep problems.

Excessive sucking.

Fever.

Hyperactive reflexes.

Hypertonicity (pathologically increased muscle tone).

Trembling (tremors).

Seizures.

Convulsions.

Poor feeding.

Slow weight gain.

Treating NAS

The recommended treatment for NAS will depend on what type of drug the mother used, the infant’s health, and whether the baby was born full-term or preterm. Babies with NAS are usually fussy, so doctors may ask the parents to use “TLC”, or tender loving care, to help the baby calm down. Strategies may include 5:

Gently rocking the baby back and forth.

Swaddling the baby.

Turning down the lights and minimizing noise around the baby.

When babies are born with severe NAS, they may need medicines such as morphine and methadone to help treat their withdrawal symptoms. In some cases, a second medicine such as clonidine may be added to manage troublesome symptoms. Doctors may also recommend breastfeeding if the mother is using methadone or buprenorphine.

A baby with NAS may require treatment anywhere from 1 week to 6 months, depending on severity. After that, the baby may continue needing special care and attention 5.

Are Any Medications Safe to Use During Pregnancy?

It is increasingly common for women to use use opioid painkillers during pregnancy. In fact, in a study of more than 1 million pregnant women enrolled in Medicaid, about 1 in 5 were prescribed opioids by their doctors between 2000 and 2007 7.

Many women experience pain during pregnancy, such as low back pain, pelvic pain, or migraines. Although doctors may prescribe opioids to manage acute pain during pregnancy, the American Pain Society warns that the potential risks should be carefully considered prior to prescribing opioid therapy to a pregnant woman 6.

Most prescription opioids are labeled under category C by the FDA. This categorization indicates that there is evidence of potential harm to the fetus from animal studies—and that there is not enough evidence from human studies—to conclude that it is safe. However, oxycodone is classified in category B, which means that there is no evidence of harm to the fetus from animal studies but, as with category C, there is not enough evidence from human studies to deem it safe 8.

Due to the unknown safety of opioid painkillers for pregnant women, a woman and her doctor should always thoroughly discuss the risks and benefits of taking opioids to manage pain during pregnancy.

Quitting Painkillers While Pregnant

Opioid addictions are, in part, characterized by physical dependence and tolerance. When a person becomes tolerant to opioid painkillers they will need higher doses to feel the same effects. Physical dependence is a common result of continued use. Once a person develops a physical dependence, they will likely experience withdrawal symptoms if they stop using opioid painkillers.

If a pregnant woman abruptly stops taking opioid painkillers, it could result in unwanted health consequences, including 9:

Preterm labor.

Fetal distress.

Fetal death.

There are options to help with withdrawal from opioids. Methadone is the most researched drug for use during pregnancy 10. Although methadone is not formally sanctioned by the FDA for treatment of opioid dependence during pregnancy, it is currently the standard of care and recommended by many doctors for opioid-dependent women who are pregnant 10.

Despite support from the medical community for methadone use during pregnancy, the drug does come with a risk of side effects. For example, methadone can cross the placenta and reach the developing fetus, which can alter fetal heart rate 10. Methadone can also cause s withdrawal syndrome in 60-80% of neonates 11.

Methadone maintenance therapy has a long history of use, dating back to the late 1960s. Buprenorphine maintenance therapy has been used to treat opioid dependence among pregnant women since the mid-2000s. Buprenorphine is prescribed in an outpatient setting, while methadone maintenance requires a woman to go to a clinic daily to receive her dose. More studies are needed in order to properly understand the risks and benefits of these two therapies 4.

Methadone therapy is often preferred by physicians because it provides better rates of relapse prevention, reduces the fetus’s exposure to drugs, improves a woman’s adherence to medical care, and decreases the risk of unfavorable neonatal outcomes, such as low birth weight.

Given that the consumption of prescription opioids has increased dramatically in the United States, it is important for women to understand the risks of taking these medicines while they are pregnant. If you are pregnant, talk to your health care provider about the medications you are taking to prevent potential harm to your developing fetus.

Treatment for Opioid Addiction

If you or a loved one is facing an addiction to opioids during pregnancy, there are options for treatment. The most important and first step to take is to tell your doctor about your opioid use. Every mother wants the best for her baby, andby disclosing your drug use with your doctor, you are taking the necessary steps to ensure your baby’s health and wellbeing.

Some facilities may also offer aftercare services such as postpartum support. This can be extremely helpful in preventing relapse after leaving the facility.

It is important for treatment programs—either inpatient or outpatient—to address underlying issues of dependence with behavioral treatment. Treatment types may include:

Cognitive behavioral therapy (CBT): This type of intervention helps you to develop coping mechanisms for when you have a craving or urge to use opioids. CBT has been shown to be effective in preventing relapse.

Contingency management: This type of intervention uses positive reinforcement like rewards and incentives. Your therapist may reward you with a gift card, voucher, or special privilege if you reach a treatment goal such as attending counseling sessions or staying drug-free.

Outpatient programs offer more flexibility and are a great option for mothers with obligations outside of treatment such as school, childcare, or work. Unlike inpatient treatment, you can live at home while you receive care. Generally, outpatient programs are less expensive than inpatient programs. Since therapy is at the crux of outpatient treatment, most programs offer group therapy sessions several hours each week.

Before considering going through withdrawal, detox, and/or rehab for opioid addiction, it is best to first talk to your doctor about your current opioid use. Your doctor can complete an assessment and direct you to the proper resources.

If you or a loved one is looking for treatment, give us a call today at 1-800-980-3927. Our treatment placement specialists are available 24/7 to help you find a facility that fits your needs.